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Biomedical subjects

M Montalto

Publications and source records attributed to M Montalto.

At least 37 records · Page 2Linked to original sources
PubMed1999

Water maze performance is unaffected in artificially reared rats fed diets supplemented with arachidonic acid and docosahexaenoic acid.

Four groups of male Long-Evans rats were reared artificially from postnatal d 5 to 18 by being fed through a gastrostomy tube with rat milk substitutes containing oils providing 10% linoleic acid and 1% alpha-linolenic acid (g/100 g fat); with the use of a 2 x 2 design, they were fed one of two levels of arachidonic acid (AA) and docosahexaenoic acid (DHA) (0.0 and 2.5 g/100 g of fatty acids). A fifth artificially reared group was fed a diet high in saturated fat, and a sixth group was reared by dams fed a standard AIN-93M diet. The pups were weaned onto modified AIN-93G diets, with a fat composition similar to that fed during the artificial rearing period. Behavioral testing was conducted between 6 and 9 wk of age; brain lipid composition was then assessed. Relative to the unsupplemented group (0.0 g/100 g AA and DHA), dietary supplementation resulted in a wide range of AA (84-103%) and particularly DHA (86-119%) levels in forebrain membrane phospholipids. AA supplementation increased AA levels and decreased DHA levels, and DHA supplementation increased DHA levels and decreased AA levels, with the magnitude of these effects dependent on the level of the other fatty acid. DHA levels were very low in the saturated fat group. The groups did not differ on the place or cued version of the Morris water-maze, but on a test of working memory, the saturated fat group was impaired relative to the suckled control group. Further correlational analyses in the artificially reared animals did not support a relationship between the wide range of DHA and AA levels in the forebrain and working-memory performance.

Animals↗
PubMed1998

How safe is hospital-in-the-home care?

OBJECTIVE: To describe the rate of negative, unexpected and adverse events associated with hospital-in-the-home (HIH) care in an established unit, and to validate indicators of safety for HIH care. DESIGN: Prospective descriptive survey. PATIENTS AND SETTING: 231 patients, who would otherwise have required hospitalisation, accepted for acute home-based care by the HIH unit at Frankston Hospital, a 350-bed hospital serving a population of 240,000 on the south-eastern boundary of Melbourne. MAIN OUTCOME MEASURES: The following indicators of safety: patient telephone calls to the on-call service; unscheduled staff callout to patients' homes; return to hospital during an HIH admission; and return to hospital after discharge. RESULTS: 190 acute admissions were examined. Planned same-day admissions were uneventful and excluded from the analysis. The therapies provided were intravenous therapy (mainly antibiotics), anticoagulation, and wound care. Unplanned patient telephone calls were received in 6.3% of admissions; 5.8% of acute admissions required an unscheduled staff home attendance; 4.2% of episodes resulted in a return to hospital, of which 2.6% required continued care in hospital; 2.2% of episodes resulted in a return to hospital within 14 days of discharge for a related problem. The rate of iatrogenic adverse events was 3.5%. CONCLUSIONS: HIH care is very safe. This study may help define safety standards for HIH care so that future studies can compare them with those of traditional inpatient care.

Adolescent↗
PubMed1998

Long-chain polyunsaturated fatty acid levels in formulae influence deposition of docosahexaenoic acid and arachidonic acid in brain and red blood cells of artificially reared neonatal rats.

We studied the effects of dietary long-chain polyunsaturated fatty acids (PUFA) on the fatty acid composition of the brain and red blood cells in gastrostomized rat pups reared artificially from postnatal Days 5-18. These pups were fed rat milk substitutes in which the fat comprised 10% linoleic acid and 1% alpha-linolenic acid and, using a 3 x 3 factorial design, one of three levels of both arachidonic acid (AA) and docosahexaenoic acid (DHA) supplied as single cell microbial oils (0.0, 0.4 and 2.4% fatty acids). A tenth group was reared by nursing dams. The fatty acid composition of the phosphatidylethanolamine (PE) and phosphatidylserine/phosphatidylinositol (PS/PI) phospholipids in the brain and red blood cells on Day 18 reflected the dietary composition in that pups receiving long-chain supplementation of each had higher levels of the supplemented PUFA, but lower levels of the other, relative to unsupplemented groups. In contrast to these results, there were few changes in the brain in phosphatidylcholine (PC) phospholipids whereas, in the red blood cells, changes in PC were similar to those in PE and PS/PI. Regression analyses showed that DHA levels in the brain correlated more closely with those of the red blood cells than did AA levels. The results of this study indicate that, although supplementation of formula with AA or DHA during the period of rapid brain development in rats increases deposition of the long-chain PUFA in the developing tissues, each also affects the levels of the other.

Animals↗
PubMed1998

General practitioner involvement in hospital in the home. The hospital's view.

INTRODUCTION: Programs involving hospitals and general practitioners (GPs) have become more commonplace, with a greater emphasis on integration of health services emerging over the last generation. Hospital in the home (HIH) refers to the delivery of acute hospital services such as intravenous therapy, anticoagulation and wound care to patients in their own homes. This study sought to determine the extent to which HIH units had involved urban GPs, issues related to GP involvement, and the likely future of such involvement. METHOD: Telephone administered structured survey to all urban HIH coordinators/directors in Melbourne, Australia. RESULTS: All 14 identified HIH coordinators were interviewed. Five units reported a direct role for GPs, six reported no role and three reported a limited role in managing intercurrent illnesses. Coordinators felt that variability of GP response and skills, GP availability and patient control were significant issues. An increase in future GP involvement was uncertain and conditional. DISCUSSION: One-third of urban hospitals surveyed have involved GPs in their programs. However, issues such as variability in skills, enthusiasm and availability threaten expansion of such involvement. This calls for a review in the way GPs are involved in hospital programs, and for better relationships with hospital nursing staff. Limiting the number of involved GPs in any hospital-GP program may offer advantages to both groups. Despite the movement of hospital work into the community, GP involvement in such work is not guaranteed.

Family Practice↗
PubMed1998

Effect of moderate and heavy alcohol consumption on intestinal transit time.

BACKGROUND: Alcohol abusers frequently have gastrointestinal symptoms, such as diarrhea, nausea and vomiting. In the genesis of these symptoms multiple mechanisms are involved, including alteration of gastrointestinal motility. The aim of our study was to investigate oro-cecal transit time (OCTT) using the H2-breath test (H2-BT) in moderate and heavy drinkers. MATERIALS AND METHODS: We studied 40 chronic drinkers: 20 with heavy alcohol consumption (> or = 60 g/day for men and > or = 40 g/day for women) and 20 with moderate alcohol intake (< 60 g/day for men and < 40 g/day for women). The control group consisted of 20 teetotal subjects. All subjects underwent a lactulose H2-BT to assess OCTT. RESULTS: OCTT in heavy alcohol drinkers ranged from 100 to 240 min, with a mean of 149.5 min, while OCTT in moderate drinkers ranged from 70 to 140 min, with a mean of 109 min. In the control group the mean OCTT was 100 mins, ranging from 70 to 130 min. The difference between alcohol abusers and controls was statistically significant; on the contrary, there was no statistically significant difference between moderate alcohol drinkers and teetotallers. CONCLUSIONS: Our study shows that only in chronic heavy alcohol drinkers is OCTT clearly increased. Multiple mechanisms are hypothesized to explain motility disorder, such as visceral autonomic neuropathy, inflammation and loss of contractile proteins of smooth muscle layer of the small intestine.

Adolescent↗
PubMed1997

Home and hospital intravenous therapy for two acute infections: an early study.

AIM: To study the severity, treatment and outcome of patients with cellulitis and pyelonephritis treated with intravenous antibiotics in either a hospital in the home unit (HHU) or traditional inpatient beds. METHOD: Retrospective case reviews were used. All patients with cellulitis and pyelonephritis from January 1995 until January 1996 who were assessed as appropriate for HHU care were included. Each HHU case was included. The traditional in-hospital group was defined as patients who had been assessed as suitable for HHU, but who did not enter the HHU for non-clinical reasons. Background variables were: patient age; patient gender; prior treatment with antibiotics; temperature on presentations; creatinine on presentation; leucocyte count on presentation; parenteral medication used; and preexistent conditions. Outcome variables were: number of days until febrifuge; total duration of stay; duration of in-hospital stay; duration of HHU stay; patient incidents; and status at discharge. RESULTS: The two groups exhibited similarities on patient and condition characteristics, although differences in the types of antibiotics used were found. A positive clinical outcome was achieved in every patient. In-hospital duration of stay was briefer in the HHU groups. DISCUSSION: These early results are encouraging for home intravenous therapy. Further studies, controlled trials if possible, are now required to establish these findings more definitively.

Acute Disease↗
PubMed1997

[Intestinal permeability].

Intestinal mucosa has an absorptive function and acts also as a selective barrier against potential antigenic, toxic and carcinogenic substances. Intestinal permeability can be defined as the capacity of mucosal surface to be penetrate by specific substances through unmediated diffusion. There are two theories about molecular permeation routes: the first one hypothesizes a transcellular (through small pores), a paracellular (through big channels) and a lipophilic pathways; the second one gives a key role only to paracellular tight-junctions. In many diseases we can find changes in intestinal permeability evaluable by simple and non invasive tests, administering "per os" probe molecules. These substances cross the epithelium in different way and amount according to their physicochemical features and mucosal integrity; then they reach circulation and are eliminated in urines where they can be detected. The most frequently molecules used are mono/disaccharides, 51Cr-labelled ethylenediaminetetraacetate (51Cr-EDTA) and polyethylene glycol (PEG). This simple method has become more and more used for diagnostic and speculative aims. These intestinal permeability tests have a low specificity so they cannot be used for a definitive diagnosis of intestinal disease; nevertheless, the high sensitivity for intestinal mucosal damage could make them a necessary method to evaluate mucosal integrity after therapy, to select patients with a specific symptoms and to support, particularly in pediatric populations, more specific and invasive diagnostic tests.

Humans↗
PubMed1997

An audit of patients admitted for home intravenous therapy directly from the emergency department.

The Hospital in the Home Unit (HHU) provides home intravenous therapy to acute inpatients. The aim of this audit was to assess the practice of accepting patients for home intravenous therapy directly from the emergency department by describing the frequency and type of clinical conditions managed, and recording the outcome and adverse events of such admissions. Consecutive patient admissions to the HHU directly from the emergency department over a 15-month period were included. The policy of accepting patients for home intravenous therapy from the emergency department will continue. Care with diagnosis and HHU assessment is required. Complications should be expected, and a reliable on-call service is essential.

Acute Disease↗
PubMed1996

Patients' and carers' satisfaction with hospital-in-the-home care.

AIM: Hospital-in-the-Home Units (HHUs) offer acute care, such as the administration of intravenous antibiotic therapy, to appropriate and consenting patients in their homes. This study sought to determine the satisfaction of a group of patients and carers to a hospital in the home program in Victoria, Australia. METHOD: A descriptive survey based on a telephone administered structured interview was conducted. PATIENTS admitted to the HHU from December 1994 until the end of June 1995, and their nominated carers, were approached for their participation 2-3 weeks after their discharge. RESULTS PATIENTS: Surveys were completed for 67 of a total 79 patients (84.8%). A preference for the convenience and comfort of home was the commonest reason cited for agreeing to enter the HHU (45 or 67.2%). Almost all respondents (66) would use the service again if the opportunity arose. Benefits associated with the home environment were the commonest perceived advantages of HHU care (42, 62.3%). Carers: Sixty-five carers from a possible 79 were interviewed. Most carers were women (spouses or mothers), and gave their occupation as home carer or retired. Sixty-two carers were confident in their role in the HHU. A similar number stated that they would act as carers again, and 61 would recommend the role to others. CONCLUSION: This study demonstrates that patient and carer preference will act as an incentive in the development and acceptance of HHU care.

Adolescent↗
PubMed1996

Helicobacter pylori eradication using one-week low-dose lansoprazole plus amoxycillin and either clarithromycin or azithromycin.

AIM: To evaluate and compare two 1-week low-dose triple therapies based on lansoprazole, amoxycillin and a macrolide in eradicating Helicobacter pylori. METHODS: Seventy consecutive patients, suffering from dyspeptic symptoms with H. pylori infection, were randomly allocated to one of two treatment groups: (A) (LAC; n = 35) lansoprazole 30 mg once daily, amoxycillin 1000 mg b.d., clarithromycin 250 mg b.d., all for 7 days; and (B) (LAA; n = 35) lansoprazole 30 mg once daily and amoxycillin 1000 mg b.d., both for 7 days, plus azithromycin 500 mg once daily for only 3 days. The H. pylori status was evaluated by means of histology and rapid urease test at entry and 8 weeks after treatment. RESULTS: Three patients did not complete the treatment: one in the LAC group was withdrawn owing to severe side-effects; two patients in the LAA group stopped the treatment prematurely. H. pylori eradication was obtained in 28 of 34 (82%; 95% CI = 66-93%) patients in the LAC group and in 20 of 33 (61%; 95% CI = 42-77%) patients in the LAA group. The difference is significant (P < 0.029). On intention-to-treat analysis, the rates of eradication were (28 of 35 patients, 80% in the LAC group and 20 of 35 patients, 57% in the LAA group. Side-effects occurred in nine (26%) and six (18%) patients in the LAC and LAA groups, respectively. CONCLUSIONS: Low-dose lansoprazole plus amoxycillin and clarithromycin is more effective than low-dose lansoprazole plus amoxycillin and azithromycin, but it gave a greater incidence of side-effects.

2-Pyridinylmethylsulfinylbenzimidazoles↗
PubMed1996

Differences in patient throughput between community health centre and private general practitioners.

This study sought to compare the rate of patient throughput by community health centre general practitioners (GPs) and their private practice fee-for-service counterparts. The study group comprised 44 community health centre GPs (out of an identified 51) in 16 community health centres; the control group comprised 268 GPs. Community health centre GPs were found to have significantly fewer consultants and significantly smaller rebates than their private practice counterparts. The difference of means for consultation numbers and rebates was 30.3 per cent. The pattern was reversed in the case of rural community health centre GPs (who retain fee-for-service arrangements). Figures are uncorrected for patient status, and data relate to Medicare billing practices rather than observed activity or outcome. However, at face value they would indicate that if Australian general practice moved to a community health centre model, with predominantly salaried GPs, then patient throughput in general practice could be expected to drop. Whether these reflect the impact of incentives on throughput and, if so, whether this indicates a difference in the quality or accessibility of the service provided to patients is not certain.

Adult↗
PubMed1996

Role of dental plaque in the transmission of Helicobacter pylori infection.

With regard to the role of dental plaque in the transmission of Helicobacter pylori infection, data from the literature vary greatly, owing to differences in sample collection and H. pylori-detecting techniques. Using the polymerase chain reaction (PCR), we have determined the incidence of H. pylori colonization in the dental plaque of 31 consecutive patients who underwent gastroscopy. The patients were divided into two groups on the basis of H. pylori infection, determined by Giemsa stain and the rapid urease test: group A made up of 21 H. pylori-positive patients and group B with 10 H. pylori-negative patients. Our PCR assay of dental plaque samples proved negative in all group A subjects but was positive in only one patient in group B. In our study, we found that H. pylori had a low prevalence (3.2%) in the oral cavity, with no significant relationship between gastric mucosa and dental plaque colonization. More comprehensive studies are needed to determine whether dental plaque is an important reservoir in the epidemiology of H. pylori-induced gastric disease.

Adult↗
PubMed1996

Low-dose omeprazole plus clarithromycin and either tinidazole or amoxycillin for Helicobacter pylori infection.

BACKGROUND: The aim of our study was to compare two 1-week, low-dose triple therapies for Helicobacter pylori eradication. METHODS: One hundred consecutive patients, suffering from dyspeptic symptoms with H. pylori infection, were randomly allocated to 7 days of treatment with omeprazole 20 mg o.m. plus clarithromycin 250 mg b.d. and either tinidazole 500 mg b.d. (group A: n = 50, 19 with peptic ulcer) or amoxycillin 1000 mg b.d. (group B: n = 50, 20 with peptic ulcer). H. pylori-status was evaluated by means of histology, culture and urease test, at entry and 8 weeks after treatment. RESULTS: Three patients did not complete the treatment. H. pylori eradication was obtained in 35 patients from group A (73%) (95% CI, 55-82%) and in 40 patients from group B (82%) (95% CI, 66-90%). On intention-to-treat analysis, the rates of eradication were similar. Side-effects occurred in seven patients from group A (14.58%) and in four patients from group B (8.33%), but none discontinued therapy because of side-effects. CONCLUSION: Both triple 1-week, low-dose omeprazole therapies gave good eradication rates with infrequent side-effects.

Adult↗